Synulox vs Augmentin.

Re: Synulox vs Augmentin.

Mark Hedberg — Wed, 24 Nov 2010 20:57:35 GMT

Fascinating! I had no idea synulox's peak was twice as high after i/m. Was there any word about drug half-life?

Re: Synulox vs Augmentin.

Vikki Halliday LLB — Wed, 24 Nov 2010 14:45:45 GMT

[quote user="Clive Ansell"]

May I also draw you attention to the fact that Synulox RTU does not have a peri-operative claim on the data sheet. The best advice that I can give you is to contact a Key Opinion Leader at one of the universities and get their views on the pros and cons of using either Augmentin or Synulox.

[/quote]

As far as I am aware, no antibiotic has a specific perioperative claim for orthopaedic or soft tissue surgery.

And IMHO, Mr Ness is a KOL.

Re: Synulox vs Augmentin.

Evelyn Barbour-Hill — Wed, 24 Nov 2010 13:09:30 GMT

[quote user="Clive Ansell"]

When Synulox™ RTU is administered by the licensed routes and at the licensed doses, the Minimum Inhibitory Concentration (MIC) of data sheet bacteria are reached, and associated specified conditions are resolved. However I am unable to tell you the exact time that the exact MIC is exceeded for each the organisms in each target tissue.

[/quote]

That's what you might call a cautious reply

Re: Synulox vs Augmentin.

Clive Ansell — Wed, 24 Nov 2010 12:55:16 GMT

From Pfizer.

Re: Synulox vs Augmentin.

Clive Ansell — Mon, 22 Nov 2010 20:51:08 GMT

[quote user="Mark Holmes"]

Furthering this discussion I am unable to see the point of sub cut fluids in most cases. Surely if iv is not possible oral electrolytes would be better? Administration difficulties aside.

[/quote]

I think s/c fluids have their place. Of course i/v administration is usually best, particularly in hypovolaemic patients. But for small furries (i still struggle with hamster i/v's) , fractious cats where taking them off an i/v would be impossible, or cats where they are/can not be hospitalized, or where they are hospitalized unattended - I'm always cautious of overhydration in unmonitored small patients.

Re: Synulox vs Augmentin.

Laurence Webb — Mon, 22 Nov 2010 17:00:01 GMT

[quote user="Clive Ansell"]

From Pfizer regarding Synulox.

Subcutaneous injection: Peak serum levels occur at approximately 1-2 hours post injection, with the concentration being approximately 2.2-2.8mcg/ml.

Intramuscular injection: Peak serum levels occur at approximately 2 hours post injection, with the concentration being approximately 5.0mcg/ml (+/- 0.4).

If this is taken as gospel then there could be a case for a one off i/v injection in cases where rapid antibiosis is indicated or in patients with poor perfusion where uptake from a s/c injection will be slow.

[/quote]How long does it take to acheive therapeutic levels rather than peak levels? Interesting to note that the peak serum levels via IM injection are approximately twice those achieved with s/c injection.

Re: Synulox vs Augmentin.

Martin Atkinson — Mon, 22 Nov 2010 14:33:45 GMT

[quote user="Mark Holmes"]

Onsior actually works faster orally than it does by injection (I don't have the reference but there is a paper demonstrating it).

Agreed

Furthering this discussion I am unable to see the point of sub cut fluids in most cases. Surely if iv is not possible oral electrolytes would be better? Administration difficulties aside.

This is one of the longest running 'are they/aren't they' arguments in the book. There is no doubt that I/V fluids are essential to restore fluid volume rapidy in shock/hypovolaemia but for maintenance the S/C route is as good and is far superior to the forced oral route in terms of ease of administration of suitable volumes. Clearly if an animal is drinking enough voluntarily then oral fluid intake is best . Fashion varies on this one though, and old codgers who didn't have the skill to give IV fluids swore by the S/C route. They were dragged screaming and shouting into the 20th century (well those who didn't die of old age or retire) but now they're been shown to be not completely wrong after all. It is accepted these days that cats with renal disease do not take enough water by drinking alone even if they're polydypsic, and regular S/C fluids are a good idea given that keeping them on a drip is impractical, hence my post earlier in the year about home administration of S/C fluids through skin buttons. I will quite often give a bolus of S/C fluid to an animal that is only marginally dehydrated especially if it's closing time or they can't afford I/V.

[/quote]

Re: Synulox vs Augmentin.

Clive Ansell — Mon, 22 Nov 2010 14:03:42 GMT

From Pfizer regarding Synulox.

Subcutaneous injection: Peak serum levels occur at approximately 1-2 hours post injection, with the concentration being approximately 2.2-2.8mcg/ml.

Intramuscular injection: Peak serum levels occur at approximately 2 hours post injection, with the concentration being approximately 5.0mcg/ml (+/- 0.4).

Re: Synulox vs Augmentin.

Mark Holmes — Mon, 22 Nov 2010 10:39:20 GMT

[quote user="Martin Atkinson"]The principle of giving an 'injection to start him off' may not always be just for show or to justify an injection fee - especially with anorexic patients that are difficult to pill, an injection may get them feeling well enough to get the tablets in them via their food.[/quote]

Not always, but is there a need for a NSAID injection in a lame dog? Onsior actually works faster orally than it does by injection (I don't have the reference but there is a paper demonstrating it). The same (although I have no figures to show it) could be said for a simple skin infection either traumatic or pyoderma. Convenia has altered the discussion somewhat for cats.

I have maintained for a long time that the blood supply to fat is poor and oral medication is likely to be equally suitable or more suitable providing the patient is not vomiting. Although I will conceed that oil based depot injections and water based injections will differ

I do use augmentin iv if I want very high plasma levels very quickly, although Malcolms post earlier may change that. Although I often give a sub cut synulox shortly afterwards and then move to oral as soon as possible. I have never seen the justification of augmentin iv q 8hrs, there seems to me to be no reason to expect better plasma levels in these circumstances over sub cut or oral medication at the appropriate dose.

Furthering this discussion I am unable to see the point of sub cut fluids in most cases. Surely if iv is not possible oral electrolytes would be better? Administration difficulties aside.

Re: Synulox vs Augmentin.

Martin Atkinson — Mon, 22 Nov 2010 10:20:14 GMT

[quote user="Michael Woodhouse"]

If you want to see how quickly subcutaneous injections work give a lactating cow a 1ml oxytocin sub cut, you can see the effect in less than 1 minute.

Domitor sedation sub cut animal sleepy in 10 minutes.

I try to give peri-operative abs and analgesic with the pre-med.

I think the 'injection to start him off' is more for show than any benefit to the patient [sulphonamides excluded in the horse].

[/quote]

I think you're on tricky ground comparing the absorption rates of different drugs with potentially different pharmacodynamics. I tend to use I/V Augmentin in cases of septicaemia/shock in the belief it will get to the parts an S/C or I/M injection may not reach quite as quickly but my understanding of pharmacodynamics (gosh I've used a big word twice) may be lacking. The principle of giving an 'injection to start him off' may not always be just for show or to justify an injection fee - especially with anorexic patients that are difficult to pill, an injection may get them feeling well enough to get the tablets in them via their food.

Re: Synulox vs Augmentin.

Michael Woodhouse — Sun, 21 Nov 2010 00:29:04 GMT

[quote user="Tiago Cardoso"]It is my understanding that Synulox lasts for far too long to be used as a periop abx.[/quote]

Pardon?

If you want to see how quickly subcutaneous injections work give a lactating cow a 1ml oxytocin sub cut, you can see the effect in less than 1 minute.

Domitor sedation sub cut animal sleepy in 10 minutes.

I try to give peri-operative abs and analgesic with the pre-med.

I think the 'injection to start him off' is more for show than any benefit to the patient [sulphonamides excluded in the horse].

Re: Synulox vs Augmentin.

Tiago Cardoso — Sat, 20 Nov 2010 21:22:07 GMT

I only use Augmentin as a perioperative antibiotic in ortho and some hollow viscus surgery - where a high tissue concentration is desirable but only during the tissue handling phase. It is my understanding that Synulox lasts for far too long to be used as a periop abx.

Re: Synulox vs Augmentin.

vs0u — Sat, 20 Nov 2010 15:27:47 GMT

I think IV antibiotics are only necessary in septicaemia or animals with collapsed circulation/severe dehydration - can't see any benefit for dentals or routine stuff on healthy animals. It's hard to believe circulating levels from a s/c injection rise as fast as they do but the body is amazing!

Re: Synulox vs Augmentin.

Sandra Milburn — Sat, 20 Nov 2010 14:44:55 GMT

Just another thought: does hydration status not also influence absorption on s/c Synulox? eg RTA in shock with contaminated wounds. Chances are the patient will be put on the drip, so can give iv antibiotics asap. What about s/c ones?

Re: Synulox vs Augmentin.

Vikki Halliday LLB — Sat, 20 Nov 2010 14:26:46 GMT

Malcolm Ness posted on this topic in a forum thread "Agmentin Stability", his comments were;

"but ........ a few years ago we did a literature review on this and confirmed that following either IM or sub cut injection of regular synulox/nisamox etc injectable , each of the active ingredients appears to reach effective plasma levels very, very quickly. I can't remember the exact numbers but it was in the range of seconds to a few minutes. Consequently, we now use a single IM injection of potentiated amoxycillin given as the patient is draped for surgery. Several residents have questioned the practice but, having been sent away to repeat the review they have come round to our way."

I agree, I find Augmentin an abuse of the cascade system for those with no faith in licenced products, albeit given by an off-licence route.

Re: Synulox vs Augmentin.

Mark Hedberg — Sat, 20 Nov 2010 14:20:42 GMT

If there is any severe concern about infection, i usually give synulox and baytril; good synergistic cover. I'm not convinced iv antibiotics are superior; that said in truly time sensitive critical cases (severe trauma, rta with badly contaminated wounds, etc) i often do iv augmentin. I confess it is not evidence based medici e, i have seen no definitive proof it is superior or inferior.